Hormone replacement therapy (HRT)<\/ins> \u2013 not cognitive behavioural therapy \u2013 should be offered as a first-line treatment to women with menopause symptoms, according to the National Institute for Health and Care Excellence (NICE).<\/p>\n\n\n\n Guidance on menopause management published<\/a> by the health watchdog says hormone replacement therapy is the preferred treatment for managing menopause symptoms.<\/p>\n\n\n\n It follows draft guidance published by NICE in November 2023 which said patients experiencing menopausal symptoms should be offered CBT \u2018alongside or as an alternative to\u2019 HRT, prompting widespread criticism from healthcare professionals and the public.<\/p>\n\n\n\n The final version now states CBT should only be considered for patients who are taking HRT but are still having symptoms, or those who are unable or do not wish to take HRT.<\/p>\n\n\n\n Balance and Newson Health founder, GP and menopause specialist Dr Louise Newson, said while it was welcome to see HRT as the preferred treatment for the menopause, it was a \u2018disappointing update overall\u2019.<\/p>\n\n\n\n \u2018The focus remains primarily on vasomotor symptoms \u2013 hot flushes and night sweats \u2013 which are, for many women, not the main symptoms of perimenopause and menopause,\u2019 she added.<\/p>\n\n\n\n \u2018Most women experience brain symptoms \u2013 brain fog, low mood, anxiety, poor concentration, sleep disturbances, memory problems and fatigue \u2013 and these are things we know are unlikely to be alleviated in the long term by CBT, as suggested.\u2019<\/p>\n\n\n\n The final guideline includes recommendations on:<\/p>\n\n\n\n Dr Newson added that the guidelines also do not differentiate between older, synthetic HRT and the natural body-identical hormones now more commonly prescribed.<\/p>\n\n\n\n \u2018While the word \u201crisk\u201d is mentioned three times as often than the word \u201cbenefit\u201d, these newer forms offer more benefit than risks,\u2019 she said.<\/p>\n\n\n\n \u2018The true risk comes in not taking HRT at all, with good quality evidence showing that low hormones increases the risk of heart disease, osteoporosis, type 2 diabetes and dementia.<\/p>\n\n\n\n \u2018Menopause is sorely under-researched and under-funded, and this must change. In the meantime, women deserve to have a choice, and those who want to take HRT should be able to have it prescribed. That it is now the frontline treatment is refreshing, but future documents and consultations must go further to ensure women get the treatment they deserve.\u2019<\/p>\n\n\n\n RELATED: Understanding the benefits and risks of HRT: downloadable visual aids<\/a><\/p>\n\n\n\n Publication of the final guidance comes after more than 650 members of the public<\/a> lent their voices to Newson Health\u2019s response to NICE\u2019s public consultation on the draft version, sharing personal stories about their symptoms, struggles to access treatment, and the impact of HRT on their lives.<\/p>\n\n\n\n Numerous healthcare professionals also contributed to our consultation response, including doctors, nurses and pharmacists. Counsellors, psychiatrists and psychotherapists also voiced concerns on the CBT recommendations contained in the draft version.<\/p>\n\n\n\n NICE chief medical officer Professor Jonathan Benger said<\/a> of the final guidance: \u2018We are not suggesting that CBT is an alternative to HRT. It\u2019s not an either\/or, and we have worked through the guidelines extensively to really clarify this point.<\/p>\n\n\n\n \u2018We are very keen to emphasise that HRT is our recommended first-line therapy for vasomotor symptoms and for [other] symptoms of menopause.\u2019<\/p>\n\n\n\n\u2018Disappointing update overall\u2019<\/strong><\/h2>\n\n\n\n
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Hundreds urged rethink on draft guidance<\/strong><\/h2>\n\n\n\n